Projecting volume recovery through H1 of 2021

10 Minute Read

Volume performance for the first half of the year is likely to remain suppressed compared to 2019 levels for most services. However, an accelerated vaccine rollout and concerted recovery strategies by providers could result in a more favorable outlook. Read on and download the accompanying slides to understand how volumes will trend for the first half of 2021 and the top factors impacting volume recovery that you can inflect.

Outlook for H1 of 2021

We modeled three likely paths forward for Covid-19 case and hospitalization growth—optimistic, most likely, and pessimistic scenarios. Based on our models, providers can expect national volumes in the following ranges for H1 of 2021:


Inpatient admissions are expected to remain close to baseline throughout Q1 in all three scenarios because of a large number of Covid-19 admissions. Inpatient days will likely exceed 2019 levels due to lengthy hospital stays among Covid-19 admissions and higher-acuity non-Covid-19 patients who have complicating factors from delaying care. Throughout Q2, the number of Covid-19 admissions will steadily decrease as the vaccine is administered to those most likely to have adverse consequences from infection. Volume will remain suppressed long-term due to sustained reductions in ED visits which can be the admission source for as much of 80% of inpatient volume.

Inpatient surgeries are highly correlated with the trajectory of Covid-19 hospitalizations as they are the first services to be postponed to preserve staff and space for Covid-19 patients. In all three scenarios, there will be some level of elective inpatient surgery postponements through Q1 (ranging from 4% to 21% reductions nationally compared to baseline). In the pessimistic scenario, postponements will continue through June. In the optimistic scenario, postponements will continue through March. In the most likely scenario, postponements will continue to an extent through May. A portion of these surgeries will be recovered later in the year, driving surgical volume temporarily above 2019 baseline levels.

Outpatient surgeries will also be postponed to preserve staff for inpatient units, but to a lesser extent than inpatient surgeries (4.5% reduction in the most likely scenario by the end of Q1). Providers must contend with the extended time needed to accommodate Covid-19 cleaning and safety protocols and decreased demand from consumers due to safety or financial reasons. In the optimistic and most likely scenarios, outpatient surgeries will outperform 2019 levels by the end of Q2 due to strong organic growth and from performing rescheduled services that were postponed earlier in the year.

Outpatient visits will not be subject to the same level of volatility as other services due to Covid-19 surges. By now, providers have managed to install operating procedures to accommodate patients safely with only slight reductions in throughput and efficiency. The larger impacts will be site of care shifts, namely to virtual options, which now constitute 19% of total visits and also deferrals of care among those sensitive to costs or concerned about Covid-19 exposure.

What you can do to speed volume recovery

Our Covid-19 models and volume forecasts have been built around average performance at the national level. However, we expect a large degree of variability based on local community characteristics, government policies, consumer behaviors, and organizational recovery strategies. A speedier recovery may be achieved if providers outperform across the following factors:

  1. Frequency and duration of elective surgery postponements. Some states have more stringent thresholds where mandatory elective service cancellation policies go into effect (and some don’t have regulations at all). Additionally, some state regulations only apply to inpatient elective surgeries and not outpatient surgeries. An updated list of policy orders is maintained here. Regardless of the policy confines, providers should closely monitor data trends and make cancellation decisions on a rolling basis based on real-time capacity and staffing needs to limit the duration of necessary cancellations.
  2. Vaccine distribution and uptake. As of late January, 23 million doses of vaccine have been administered across the U.S. There will likely be wider variability in the vaccination rate over time across regions based on access to distribution sites and consumer perception of the vaccine. Providers can inflect local vaccination rates by establishing accessible vaccination sites and creating a robust communications plan that is targeted toward the most vulnerable and those that are most hesitant to receive a vaccine, including conservatives, individuals aged 30-49, rural residents, and Black adults. Some patients may be motivated by a direct recommendation from their personal physician.
  3. Limits to efficiency and throughput. Added cleaning and safety protocols may extend procedure and visit times by 15% or more. Providers that can streamline new operating procedures and extend weekend and evening hours will be able to compensate for longer turnaround times and decreased efficiency.
  4. Extent of care deferrals and site of service shifts. Consumers are deferring care for both safety and financial reasons. Most providers have already installed additional safety precautions in their facilities and started to offer virtual options when able, but those that communicate and enforce the safety measures most important to consumers will be more successful at increasing comfort with seeking in-person care. Additionally, communities with more unemployment and insurance loss may need to offer special accommodations such as payment plans to avoid deferrals of care for financial reasons.
  5. Recovery of backlogged services. It’s not a given that providers will recover all elective surgeries that were postponed, even with well-established prioritization criteria for performing these surgeries. Providers with fewer workforce, bed, and operating room constraints will be able to address the surgical backlog sooner. Consumers may ultimately decide to switch to providers that can schedule them sooner, demonstrate better safety and cleaning protocols, lower their out-of-pocket costs, allow family to accompany them, or offer a less burdensome scheduling process.

Download the ready-to-use slides below for more information on the modeling methodology, scenarios, and volume trends for the first half of 2021.

Download the slides

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